[Predictive Value of a Risk Assessment Model Based on Coagulation Biomarkers for Venous Thromboembolism after...

To construct a risk assessment model for venous thromboembolism (VTE) in children with acute lymphoblastic leukemia (ALL) after transplantation, and to explore the value of this new model in predicting the risk of post-transplant VTE in children with ALL.

A total of 113 children with ALL who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at Children's Hospital of Soochow University were enrolled. According to the occurrence of VTE within 30 days after transplantation, the children were divided into VTE group and non-VTE group. Differences in the levels of coagulation markers and the distribution of other thromboembolism-related clinical risk factors were compared between the two groups. Logistic regression analysis was used to screen independent risk factors for post-transplant VTE. Based on these factors, a new VTE risk assessment model was established, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of the new model for VTE in children with ALL after transplantation, as well as to compare its advantages over traditional methods.

In the VTE group, the plasma levels of tissue plasminogen activator-inhibitor complex (t-PAIC), thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer (DD) were significantly higher than those in the non-VTE group, while the fibrinogen (FIB) level was significantly lower (all P < 0.05). In the VTE group, the duration of ALL was generally longer, and the detection rates of granulocytopenia, agranulocytosis, and peripherally inserted central catheter (PICC)-related bloodstream infection (CRBSI) were significantly higher than those in the non-VTE group (all P < 0.05). Multivariate analysis showed that t-PAIC >4.3 ng/ml (OR =30.19, P =0.005) and APTT >31.8 s (OR =12.17, P =0.015) were independent risk factors for post-transplant VTE in children with ALL. A new VTE risk assessment model was established based on these two risk factors. The model showed significantly superior performance in predicting post-transplant VTE in children with ALL compared with individual coagulation and fibrinolysis indicators, as well as the traditional Caprini score and DIC score, with an AUC of 0.90 (P =0.001).

The novel thrombotic marker t-PAIC has important clinical value in the early prediction of VTE in children with ALL after HSCT. Compared with the traditional thrombosis risk assessment models, the new model established based on t-PAIC and APTT exhibits superior diagnostic performance and clinical applicability in the pediatric ALL population.